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       Florida Senate - 2010                                    SB 2184
       By Senator Altman
       24-01567A-10                                          20102184__
    1                        A bill to be entitled                      
    2         An act relating to renal disease; creating s.
    3         627.64081, F.S.; providing legislative intent;
    4         prohibiting an insurer that covers dialysis treatment
    5         for patients who have end-stage renal disease from
    6         requiring an insured to travel more than a certain
    7         number of minutes to obtain dialysis treatment or from
    8         requiring an insured to change to another dialysis
    9         provider; prohibiting an insurer that provides
   10         coverage for dialysis treatment from shifting the
   11         responsibility for reimbursement in coverage type to
   12         another payer; requiring such insurer to provide
   13         written notice of any change in covered services,
   14         network access, reimbursement, or patient liability
   15         for dialysis or related services; prohibiting an
   16         insurer from requiring prior authorization for
   17         dialysis services more than a certain number of times
   18         each year; providing that the Insurance Code applies
   19         to violations of the act; providing that the act does
   20         not apply to benefits provided under Medicaid and
   21         other governmental programs; amending ss. 627.662 and
   22         641.31, F.S.; providing that the provisions of the act
   23         governing dialysis treatment for certain patients
   24         apply to group health insurance, blanket health
   25         insurance, franchise health insurance, and health
   26         maintenance contracts; providing an effective date.
   28  Be It Enacted by the Legislature of the State of Florida:
   30         Section 1. Section 627.64081, Florida Statutes, is created
   31  to read:
   32         627.64081Chronic renal disease.—
   33         (1) Chronic renal disease is a life-threatening condition
   34  requiring frequent and complex treatment. Access to dialysis
   35  treatment is life sustaining and can prevent more expensive
   36  complications and treatments. Due to the unique nature of
   37  dialysis treatment and the limited responsibility of private
   38  payers for these services, the Legislature intends that persons
   39  who have chronic renal disease be provided protections under the
   40  law to ensure access to the care that they need for survival.
   41         (2) Any insurer that offers a health benefit plan that
   42  provides coverage for dialysis treatment for patients suffering
   43  from end-stage renal disease may not require, as a condition of
   44  coverage or reimbursement, an insured to:
   45         (a) Travel more than 30 minutes, under normal
   46  circumstances, from the insured’s home in order to obtain the
   47  needed dialysis treatment modality, or, if the nearest access to
   48  the modality is located more than 30 minutes from the insured’s
   49  home, to travel a greater distance than the distance to the
   50  nearest location to obtain that dialysis treatment; or
   51         (b) Change to another dialysis provider.
   52         (3) During the maximum coordination-of-benefits period, any
   53  insurer that offers a health benefit plan that provides coverage
   54  for dialysis treatment for patients suffering from end-stage
   55  renal disease:
   56         1. May not take any action that could shift the primary
   57  responsibility for reimbursement in coverage type from the
   58  insurer to another payer, including, but not limited to,
   59  Medicare, Medicaid, or any other governmental program.
   60         2. Shall provide written notice to an existing insured
   61  patient and to the provider of any change in covered services,
   62  network access, reimbursement, or patient liability for dialysis
   63  or related services by certified mail at least 12 months before
   64  the effective date of such proposed change.
   65         3. May not require prior authorization for dialysis
   66  services more than twice a year. Such authorization shall, in
   67  each instance, be inclusive of all necessary components of
   68  clinical treatment as prescribed by the insured’s physician.
   70  As used in this subsection, the term “coordination-of-benefits
   71  period” means the length of time during which an employer
   72  sponsored, union-sponsored, or any other health benefit plan is
   73  the primary payer and Medicare is the secondary payer for health
   74  coverage for a person who has end-stage renal disease and is
   75  eligible for Medicare on the basis of the end-stage renal
   76  disease.
   77         (4) Chapter 624 applies to violations under this section.
   78         (5) This section does not apply to benefits provided
   79  through Medicaid or other governmental programs.
   80         Section 2. Subsection (15) is added to section 627.662,
   81  Florida Statutes, to read:
   82         627.662 Other provisions applicable.—The following
   83  provisions apply to group health insurance, blanket health
   84  insurance, and franchise health insurance:
   85         (15) Section 627.64081, relating to dialysis treatment for
   86  insureds suffering from end-stage renal disease.
   87         Section 3. Subsection (44) is added to section 641.31,
   88  Florida Statutes, to read:
   89         641.31 Health maintenance contracts.—
   90         (44) A health maintenance contract that provides coverage
   91  for dialysis treatment for patients suffering from end-stage
   92  renal disease must comply with s. 627.64081, and the penalty
   93  provisions of this chapter apply to this subsection.
   94         Section 4. This act shall take effect October 1, 2010.

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